Fracture nail guide



' i y 7; 1940. w. w. NAUTH 2.200.120

FRACTURE NAIL GUIDE Filed April 30, 1938 2 Sheets-Sheet i [NVENToR Vl ALTEE W/VAUTH 301d, l 14M ATTORNEYS M y 7, 1940. w. w. NAUTH 2.200.120

FRAC'I'UKE NAIL GUIDE Filed April 30. 1938 2 Sheets-Sheet 2 [NVENTOR 5W41. TE/Z W lV/IUTH @(PM, /MM

Patented May 7, 1940 UNITED STATES PATENT OFFICE 14 Claims.

The present invention relates to an improved method and apparatus forfixation of fractures through the neck of the femur.

Heretofore there have been devised various methods of fixation offractures of the neck of the femur in which the fixation is accomplishedby wires, bolts, or nails, inserted through the neck of the femur so asto locate and affix the fractured portions. One of the commonestprocedures at the present time comprises the steps of first aligning thefractured portions of the neck of the femur by moderate traction withabduction to the well leg, followed by a reduction of the fracture bythe Ledbetter manipulation as described by Key and Conwell in their bookentitled Fractures, Dislocations and sprains, page 826, which waspublished in 1934 by C. B. Mosby Company, St. Louis, Missouri. Thefractured portions are then pinned together by Kirchner wires, the planeand angle of each wire being determined largely by guess, and checkedafter it is placed by anterior and lateral X-ray pictures.

In a modification of this procedure the Kirch- 25 her wires are placedone after the other, the plane and angle of each wire being determinedby hand, and checked after being placed by anterior and lateral X-raypictures, until a Kirchner wire is finally positioned along the axis of30 the neck of the femur. A hollow drill is then lowered over theprotruding end of the Kirchner wire and an enlarged hole drilled for theinser- "on of a Morrison bolt or Smith-Peterson nail is driven throughthe bone. The bolt or nail 35 serves as the load-carrying fixationmember during the union of the bones.

While these procedures have yielded remarkable results, and a relativelyhigh recovery, as compared with earlier procedures in which no 40fixation and retaining devices were used, they are objectionable forseveral reasons:

First. The plane and angle of the first Kirchnor test wire in eitherprocedure is determined by the operator, and this wire is therefore en-45 tirely explanatory. In some instances it accordlngly happened thatthis exploratorywire was misdirected so that it left the neck of thefemur, or was driven through the joint.

Second. According to either of these procedures lateral X-ray picturesare taken after the first and each succeeding Kirchner wire is set, soas to check the position of the wire as an aid to setting the nextsucceeding wire. The develop ment of each x-ray picture consumes fromfive to ten minutes, during which the surgeon can do nothing, andoperating time is thus wasted and the patient exhausted. A total of fromtwo to four Kirchner wires is sometimes necessary in either procedure,and the total time consumed for the operation, therefore, frequentlyamounts I to several hours. This long operating time and consequentexhaustion contributes to fatality, especially as patients are usuallyaged persons.

Third. Where the fixation agent is a Morrison bolt or Smith-Petersonnail, the placement of four or five exploratory Kirchner wires as ameans of locating the position of the major bore is an undesirableweakening of the neck of the femur, which is already weakened by thefracture.

Fourth. The determination of the plane and angle of the initial andsubsequent Kirchner test wires is done manually and is therefore, withinthe skill of the operator. The number of operations of this character isrelatively small and there are but relatively few operators in the largecenters of population who have had sufiicient experience to perform thisoperation without placing an excessive number of test wires and.consuming an excessive amount of time in the operation.

It is an object of the present invention to provide a method and anapparatus for overcoming these deficiencies of earlier procedures.Specifically, it is an object of the present invention to provide amethod and apparatus for guiding the placement of the first Kirchnertest wire, with reference to certain landmarks of the femur, whereby thepossibility of misdirecting the initial wire is obviated.

It is also an object to provide a method and 5 apparatus for locatingthe plane and angles of a subsequent Kirchner wire or a large caliberdrill with respect to the femur landmarks and with respect to theinitially guided Kirchner test wire whereby the use of subsequentexploratory wires is obviated, or reduced to at a maximum one wire andwhereby the total operating time may be sharply reduced from severalhours to less than one hour. 1

It is a further object of the invention to provide a method of femursurgery and an apparatus by which the use of exploratory test wires maybe obviated entirely if desired and by which the major boring device maybe guided by an instrument definitely located with reference to thefemur,

It is also an object to provide an adjustable guide for a boringinstrument, which may be located temporarily in fixed position relativeto the femur and then adjusted to a position such 66 2 aaoaiao that aboring instrument guided thereby will be in alignment with the axis ofthe neck of the femur.

It is also an object to provide a guide apparatus by which surgeons ofrelatively little experience may accurately place fixation devices inthe neck of the femur, in a minimum time. and by which the angular andlateral adjustments of the drill guide may be made accurately in preciseamounts.

It is a further object to provide an instrument and a protractor deviceby which the adjustment of the instrument may be accurately gauged.

Other objects of the invention are those suggested and implied by thespecification, claims and drawings and those inherent in the methoddescribed and claimed and in the apparatus illustrated, in which Figure1 shows a side elevation view of an apparatus of the present inventionas it is applied to a dry specimen femur.

Figure 2 is a side elevational view-partly in section, showing thevarious elements separated from each other.

Figure 3 is an elevation view of the front of the instrument.

Figure 4 is an elevational view of a femur, with the instrument in placeand with a protractor guide mounted for adjustment of the instrument.

Figure 5 is a top view of a femur with the instrument in place and withthe protractor mounted for adjustment of. the instrument.

Figure 6 is an elevational view partly in section of the femur andinstrument, showing a Morrison bolt fixation device partly placed,andthe instrument ready to be removeda Figure 7 is a sectional view ofthe femur and instrument along the lines 1-7 of Figure 4.

The apparatus of the present invention is an instrument which istemporarily attached in fixed position relative to the femur during thefixation procedure. In the figures the femur shaft is designated by theletter F, the head of the femur by the letter H, and the neck of thefemur by the letter N. A fracture of the neck. of thefemur isillustrated by the irregular line extending across the neck N. Theapparatus is shown assembled on a femur in Figures 1, 4, 5 and 6 of thedrawings and comprises an angularly shaped frame generally designatedIII, which is preferably made of a single piece of corrosionresistantsteel. The frame III has a central portion H which is generally parallelto the axis of the femur F when the instrument is in. place thereon, andanother integral slide section l2 The leg portion l3 of the frame serveswith spacer block 2| which is attached to portion H, to position theslide section l2 in a definite relation to the femur.

The opposite end of the frame I!) is provided with an outwardlyextending section l6 and a' handle portion IT by which the instrumentmay be grasped and held in place in the preliminary operation ofaflixing it to the femur, as will be i described.

The central portion I l of frame I is provided with a fixed drill guideand .bushing 20 which protrudes from the frame soas to form a pivotforlocating block 2|. The locating block 2! is apertured at 22 toreceive the bushing 20 (see Figure 2) and is provided with a threadedopening 23 which receives a fastening stud 25. It will be noted that thehole 250. in frame portion H is slightly larger than stud 25. When block2i is in place and the stud loosened, the block 25 in hole 25a. Thisslight,movement provides.

the necessary displacement of the edge i of leg l3 with respect to theedges 29--29 of block 2!,

so that the instrument may be used with equal I facility on right andleft femurs.

The slide section 12 of the frame has a central transversely elongatedaperture 26, as shown in Figure 3, below which there is mounted afastening screw 21 which receives the fastening and lock nut 28. Aboveaperture 26 on the slide section there is located a tube 30 which passesthrough the frame, and 'which is permanently afllxed to the slidesection and to the right angular portion l3. The protruding end of thetube 30 is threaded at 3| so as to receive the fastening nut 32. v

overlying the slide section there is positioned a transversely movableassembly generally designated 34, which is composed of an outer plate 35and an inner plate 36. The outer plate is thickened at its upper end, asshown in Figures 1, 2, 4 and 6 so as to space the inner plate 36 fromit. The two plates 35 and 36. are fastened together by screws or rivets,not shown. The outer plate 35 also has an overhanging lip 38 whichserves to prevent the plate from turning with reference to the legportion l3 of frame Ill.

Plates 35 and 38 of assembly 34 are centrally apertured to receive thespherical portion 40 of. the drill guide 4|, as shown especially inFigures 2 and 6. When the assembly 34 is separated from the frame, asshown in Figure 2, the drill guide 4| is freely movable in its ball andsocket support and may thus be oriented at an angle either horizontallyor vertically with respect to the slide section l2 of the frame. 'Whenthe assembly 34 is in place on the frame I 0, as shown -in Figures 1 and4 and nut 32 is tightened, the

drill guide 4| may still be moved although .the. movement is somewhatrestricted. When nut 28 Referring to Figure 3 it will be noted that theinner and outer plates of assembly 34 have elongated transverseapertures 42 and 43 which permit the assembly to be moved from theleft-hand position 44, shown in heavy lines in Figure 3, to theright-hand position shown in the dotted lines in the same figure. Thepurpose of this movement from one position to the other is to permit theplane of the drill guide to be shifted when this is necessary, ashereinafter explained. The tightening of nut 32 serves to clamp assembly34 against movement.

By referring to Figure 7 it will b noted that the locating block 2! hasan inner curved surface 24 and locating edges 29-29, one of which edgescontacts thegluteal ridge 33 of femur F when the instrument is inplacethereon. When the inedge 29, as shown in Figure 7, contacts thegluteal ridge 33; when on a left femur, the u er edge 29 serves thislocating function.

In the separated'view, Figure 2, the instrument is shown as providedwith a removable drill coilet 5 strument is in place .on a right femur,the lower I. which fits the bore of drill guide 4| and which may be usedfor centering and guiding a small drill wire v5| of the same diameter aswire 31 which is used when drillingthrough tube 30. It is understoodthat this collet may be used at one stage of the operation, andsubsequently removed for the insertion of the drill 52 shown inFigure 1. The small drills 31 and ii are known in the art as "Kirchnerwires and are used for explora tory and for fastening purposes.

For use the instrument is .assembled as shown in Figure 1, with theassembly 34 in a central -position with reference to slide section II,and the block 2| pivoted to the right or left position so as toaccommodate the instrument to the right or left femurs, whichever may beunder treatment. It is noted that Figure 1 shows a Kirchner wire 31 andalso a large caliber drill 52.111 place on the instrument. These are noton the instrument when it is originally positioned on the femur but areinserted at certain stages of the operative procedure which will bedescribed. g

The edge l5 of the angularly shaped portion l3, as previously stated, isshaped to conform with the lower border of the trochantric ridge of thefemur and the locating block 2| which has edges 2929, is shaped andpositioned on the instrument with reference to the edge l5 so that anedge 29 will lie along the gluteal ridge 33 of the femur when theinstrument is in place, the necessary shifting of block 2| being made asexplained above, to accommodate the instrument to right and left femurs.

The instrument is also supplied with a detachable protractor gauge,which is illustrated in Figures 4 and 5. The gauge consists of a staff60 of a 'size such that it has a snug slip fit in drill guide 4|. Thedrill guide is preferably notched at 6| to receive a pin 62 which ismounted on staff 80 to steady the gauge and prevent it from turning withreference to the guide. Mounted on the staff 60 are a pair of protractorsegments 63 and 64, which are shaped to clear the end 65 of Kirchnerwire 31. Each of the segments is callbrated in degrees or other units asdesired. Kirchner wire 3'! is clearly discernable in an X- ray pictureand is ,a datum line for the measurement of corrections in thephotograph. The end 65 of the wire 3'! acts as an index pointer inconjunction with the protractor scales 63 and 64 for applying suchcorrections in using the instrument. The scale 63 is preferablycalibrated with line 66 as the zero line, for when the end 65 isopposite the line 66 the 'axis of drill guide 4| is parallel with theaxis of wire 31. The graduations of the protractor segments 63 and 64which are shown in Figures 4 and 5, are suggestive of any scale ofangularity which may obviously be used.

The protractor scale 63 is positioned radially at the zero of the scaleof protractor 64 and Figure 5 shows the drill guide II and protractordisplaced to supply a necessary angular correction, as hereinafterexplained.

I have discovered by measuring a large number of specimen femurs thatthe angle A of Figure 1 between the axis of the femur and the axis ofthe neck of the femur, is approximately 125 degrees and that the lowerborder ofthe trochantric ridge l4 and the gluteal ridge 33 areanatomical landmarks on the femur with reference to which the instrumentmay be readily located in use. The muscles over the femur are readilydetached up to the lower border of the trochantric ridge I4 andlaterally as far as the gluteal ridge. Dissection of the muscularattachment is resisted at the lower border of the trochantric ridge andposteriorly at the gluteal ridge by the dense flbromuscular attachmentof the muscles in these places, respectively.

In the present invention I propose to make use of these anatomicallandmarks as locating points for affixing the instrument to the femurduring theoperative procedure now to be described.

A preferred methodof using the present apparatus in an operativeprocedure comprises the following steps:

1. An anesthetic is administered to the patient. This may be a spinalanesthetic or any other anesthetic, according to the choice of theoperator.

2. The patient is then placed on a fracture table and both feet andankles are padded and traction loops are applied.

3. The patient is then placed upon the saddle of the fracture tableagainst the perineal post thereof which serves to restrain movement ofthe patient, and traction with abduction of the well leg is applied.

4. The fracture is then reduced, that is to say, the fractured portionof the bone is aligned by use of the Ledbetter manipulation, and thenthe Letbetter heel and palm test is applied to determine whetherreduction is complete. This procedure is described in the book by Keyand Conwell entitled Fracture, Dislocations and Sprains, previouslymentioned herein.

5. Fixation of the fractured portions of the neck of the femur withmoderate traction and proper rotation and abduction is then applied andX-ray photographs from the anterior, posterior and lateral positions aretaken and developed. Additional manipulation may then be applied, ifnecessary.

6. The skin is then prepared by proper antiseptic procedures and a fourinch incision is made extending downwardly along the lateral surface ofthe thigh from the middle ofthe great trochanter and the femur is freedof its muscular attachment by the use of a blunt dissector or periostealelevator. This is comparatively easy in the antero-lateral surface butas dissection is carried upward and posteriorly, two points of firmresistance are met with, which as previously described, are defined bythe dense fibro-muscu lar attachment on the lower border of thetrochanter andthe gluteal ridges respectively. The upper curved end ofthe angularly positioned plate I3 is then pushed upward against thelower border of the trochanter and the edge 29 of spacing block 2| isrotated sidewise against the gluteal ridge.

The instrument is held in position against the trochantric and glutealridges by means of handle l1, and a hole is drilled through bushing intothe sound portion of the femur. A selftapping screw 33 is then insertedthrough the bushing and the locating block and instrument proper aredrawn into a temporarily fixed'position on the femur, as shown inFigures 1 and 4. 7. A properly engaged Kirchner drill wire 3T is theninserted through tube and is drilled into the neck N of the femur to adepth determined by the surgeon as locating the point of the drill inthe head H of the femur.

' 8. Lateral, anterior and posterior X-ray photographs are then takenand disclose the plane and angle of the Kirchner wire within the neck ofthe femur (Figures 4 and 5) and enable the operator to gauge thecorrection of direction necessary for drill guide ll. As soon as the X-ray pictures are developed the exact angularity correction may bemeasured with a protractor, on the X-ray picture.

Little difficulty is experienced in finding and locating the edge ofmember I3 against the lower border of the trochanter but more care isusually required in positioning the locating edge 29 of block 2| againstthe gluteal ridge. There is seldom any vertical misalignment when usingthe present instrument, and as a consequence, the initially placedKirchner wire 31 is invariably at the proper angle of substantially 125degrees with respect to the shaft of the femur, as shown in Figure 4.

Misalignment of the block 2| with reference to the gluteal ridge has theeffect, as shown in Figure 5. of slightly misdirecting the angleof theinitial Kirchner wire test drill 31 but no difficulty is experienced dueto any reasonable misalignment here, since there is considerable leewayin the head H and neck N of the femur. If care is taken, the possibilityof failure of alignment with reference to the gluteal ridge isrelatively small.

However, for the purposes of this description, 8. misalignment isassumed, and the angle between the Kirchner wire and the axis of thefemur will appear as angle B in the X-ray picture (Figure 5).

It is also noted that in some cases a shifting of the plane of drillguide M may be necessary without a change in angularity of the drillguide, or in addition to the change in angularity of the drill guide.

and shifting the whole assembly 34 laterally. Thus, if the X-rayphotograph should disclose a configuration of the neck and head of thefemur, such as that shown by the dotted line C in Figure 5, shift ofassembly 34 to the dotted line position would be necessary in order tobring the axis of drill guide 4! in line with the proper axis, which isillustrated by the line C.

Due to the configuration of the instrument and the method of locating itwith reference to the trochantric and gluteal ridges, the first Kirchnerwire 31 which is drilled through guide will go through the upper portionof the neck of the femur, i. e., above the axis of the femur as shown inFigure 4.

9. The corrections which are ascertained to be necessary by a study ofthe X-ray photographs, may be applied to the drill guide by eye or bythe use of the protractor gauge shown in Figures 4 and 5. In the assumedcase, a correction of angle B in Figure 5 is required to bring the drillguide into proper alignment, which is represented by line L, and theprotractor is accordingly moved until the end 65 of wire 31 is oppositescale line 61 which signifies this angularity on protractor 64. In theassumed case no correction of angularit-y is necessary in the view shownin Figure 4, but if such should be required it would be applied bymoving the protractor and drill guide 4| until the appropriate scalemark on scale 63 is in line with end 65 of wire 37. It was also assumedthat no change in plane of the drill guide is necessary and henceassembly 341 is not shifted. However, if such correction should benecessary it is applied. After all of the corrections are made, thedrill guide is locked in fixed position by tightening nuts 28 and 32.

10. The drill collet is then inserted in drill guide 40 and a secondKirchner wire 5! is then When such adjustment is necessary. it isaccomplished by loosening nuts 28 and 32,

inserted through the collet and is drilled into the neck of the femur.Lateral, anterior and posterior X-rays are then taken and developed andserve as a. means of checking the position of the second wire.

11. If the second wire is in a proper position the drill collet i0 isremoved and a large drill 52 of slightly less diameter than the drillguide ll is inserted and drilled into the neck of the femur in an amountdetermined by the surgeon as sufficient to locate the end of the drillin the ball portion H of the femur. If it should be found that furthercorrections of angularity are necessary, these may be applied asdescribed in'paragraph 9 above, before the large size drill 52 is used.

12. Drill 52 is then removedand a. Morrison bolt, or any other suitabletype of fixation instrument is then inserted through the drill guide andinto the hole'produced by the large drill. Figure 6 shows a Morrisonbolt 68 in place after having been inserted through the instrument.Screw 33 is then removed and the entire instru-, ment detached.

13. The Morrison bolt which is the preferred form of attachment device,is then driven into the bone throughout the entire length of the holeand an impactor (not illustrated) is then placed over the bolt andstruck several times. This procedure permits increased protrusion of thebolt. The expanding ends 69 of the bolt are then forced into thehead ofthe femur by an expanding plunger and a fixation nut is screwed down sothat the bolt maintains the fractured ends of the femur in impactedrelation. The expending plunger and fixation nut have not beenillustrated since these are well known in the art as components of theMorrison bolt.

14. The original Kirchner guide wire 81 may then be removed, but it ispreferably left in situ as it aids fixation of the bone. If it ispermitted to stay it is clipped off evenly with the end'of the Morrisonbolt. The muscles are then brought together over the bolt and are closedby deep interrupted dermal sutures.

The wire and the bolt are normally permitted to remain in place fromabout six months to one year. The patient is usually required to remainprone for about three weeks, and it is preferable not to place anyappreciable weight upon the- When these precaujoint for about sixmonths. tions are maintained complete recovery is obtained in aboutninety per cent of the treated cases.

Many variations may be made in the foregoing preferred method withoutdeparting from the spirit of the invention; Thus, the placing of theinitial test wire may be omitted and the alignment made by study of anX-ray of the instru- I ment on the femur, the necessary correctionsbeing made from this photograph, using an edge or line on the instrumentas datum. However, I prefer to place a Kirchner wire through tube 30rince this serves to hold the fractured portions of the femur inalignment during the drilling of the larger opening and placing of theMorrison bolt or other fixation instrument.

The procedure-may also be varied by omitting the placing of a secondKirchner wire through collet v50, since this is in most cases merely aproof drill. After some experience with the instrument the placing ofthis wire is often found to be unnecessary.

Concerning variations in the apparatus: It is obviously possible toshape the frame I0 differaaoaiao entiy. Thus as one modification of theinstrument, I propose to make both guides 30 and ll adiustable, thelocating edges adjacent the trochantric and gluteal ridges beingdispensed with. In using this modification of the instrument it isinitially located generally with reference to the femur and attached.Anterior and lateral X-ray pictures then disclose the position of theinstrument on the femur. The initial test wire guide is then adjusted inan amount and direction as indicated by the photographs. However, Iprefer to use the locating edges, since experience has shown that byutilizing the trochantric and gluteal landmarks, the instrument islocatable with sufllcient accuracy that there is no danger that theinitially placed Kirchner wire will be misplaced. The advantage of thislocated procedure is that it saves about fifteen to twenty minutesoperating time.

Having thus described my invention, what I claim is:

1. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means, means for temporarilyaflixing said frame means to the femur, said frame being formed with afixed drill guide, and a universally adjustable drill guide mounted onsaid drill frame means.

2. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means, means for temporarilyafilxing said frame means to the femur, said frame being formed with afixed drill guide, a universally adjustable drill guide mounted on saiddrill frame means, and protractor means for gauging the angularity ofsaid adjustable drill guide with respect to said frame means.

3. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame having a drill guide meanshaving locating edges oriented for simultaneous contact with the'femursubstantially at the trochantric and gluteal ridges respectively saiddrill guide being oriented with respect to the locating edges so as toguide the drill through the femur neck.

4. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame having a drill guide meanshaving locating edges oriented for simultaneous contact with the femursubstantially at the trochantric and gluteal ridges respectively, saiddrill guide being oriented with respect to said locating edges so as toguide the drill through the femur neck, and handle means for said drillframe means.

, 5. A surgical instrument for use in the fixation of fractures of theneck of right and left femurs comprising a drill frame, said frame beingformed with an edge shaped for contact with the lower border of thetrochantric ridge of either the right or left femur, and a means on saidframe, said means having a pair of edges thereon located for contact oneat a time with the gluteal ridge of the right or left femur with whichthe instrument is used, when the frame is in contact with the I I Itrochantric ridge.

6. A surgical instrument for use in the fixation of fractures of theneck of right and left femurs comprising'a drill frame, said frame beingformed with an edge shaped for contact with the lower border of thetrochantric ridge of either the right or left femur, a locating means onsaid frame, said locating means having a pair of edges thereon, and anadjustable mounting for said locating means formed to permit limitedmovement of said locating means to two positions, in one of whichpositions one of said pair of edges will be oriented with respect to theframe for contact with the gluteal ridge of a right femur when the frameis in contact with the trochantric ridge of said right femur, and in theother of said positions the other of said pair of edges will be orientedwith respect to the frame for contact with the gluteal ridge of a leftfemur when the frame is in contact with the trochantric ridge of saidleft femur.

7. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means having locating edgesoriented for contact with the femur adjacent the trochantric and glutealridges respectively, handle means on drill frame means, and a drillguide mounted for movement universally with respect to said drill frame.

8. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means having locating edgesoriented for contact with the femur adjacent the trochantric and glutealridges respectively, handle means on drill frame means, a drill guidemounted for movement universally with respect to said drill frame, and asecond drill guide formed on said frame.

9. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means having locating edgesoriented for contact with the femur adjacent the trochantric and glutealridges respectively, handle means on drill frame means, a drill guidemounted for movement universally with respect to said drill frame means,and a second guide formed on said frame means, the axis of said secondguide being oriented so as to be at an angle of approximately 125degrees to the major axis of the femur when the locating edges are incontact with the trochantric and gluteal ridges, respectively.

10. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means, means for temporarilyamxing said frame means to the femur, said frame being formed with afixed drill guide, a universally adjustable drill guide mounted on saiddrill frame means and a removable collet for said universally adjustabledrill guide.

11. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means, a curved supportingedge on said frame means shaped for engagement with the lowertrochantric border of a femur, additional supporting means including asupporting edge positioned with respect to said curved supporting edgeso as to be engageable with the gluteal ridge of said femur when thecurved edge is in engagement with the lower trochantric border, meansfor temporarily attaching said frame means to said femur, and a drillguide formed on said frame means.

12. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means, a curved supportingedge on said frame shaped for engagement with the lower trochantricborder of a femur, additional supporting means including a supportingedge positioned with respect to said curved supporting edge so to beengageable with the gluteal ridge of said femur when the curved edge isin engagement with the lower trochantric border, means for temporarilyattaching said frame means to said femur, a drill guide formed on saidframe means, a second drill guide supported on said frame, said supportcomprising a ball joint with said frame means, and means for lockingsaid ball joint support to prevent movement of said second drill guide.j 13. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means, a curved supportingedge on said frame means shaped for engagement with the lowertrochantric border of a femur, additional supporting means including asupporting edge positioned with respect to said curved supporting edgeso as to be engageable with the gluteal ridge of said femur when thecurved edge is in engagement with the lower trochantric border, and adrill guide formed on said frame means.

I 14. A surgical instrument for use in the fixation of fractures of theneck of the femur comprising a drill frame means, a curved supportingedge on said frame means shaped for engagement with the lowertrochantric border of a femur, additional supporting means including asupporting edge positioned with respect to said curved supporting edgeso as to be engageable with the gluteal ridge of said femur when thecurved edge is in engagement with the lower trochantric border, saidframe being formed with a handle for easy location of the frame withrespect to the lower border of the trochanter and gluteal ridge, and adrill guide formed on said frame means and oriented with respect to thecurved supporting edge of the frame and the edge of said supportingmeans so as to guide the drill 1| through the femur neck.

WALTER W. NAUTH.

